Insurance restrictions can make it difficult for patients to regain optimal function after knee surgery or non-operative treatment for osteoarthritis. Shelbourne Knee Center’s research-backed rehab protocol maximizes recovery and function by focusing on pre-op, post-op (for surgical cases), and home-based therapy, and comprehensive patient education.
“We can see patients for a lot longer because of our rehab protocol. This allows us to continually educate our patients so they can maintain their gains after they complete therapy,” says Scot Bauman PT, DPT, a physical therapist at Shelbourne Knee Center.
Fewer Visits, Better Results
Other orthopedic surgeons often save physical therapy for post-op, due to insurance restrictions. Most physical therapy practices see patients three or four times a week for a few months.
Under Shelbourne Knee Center’s rehab protocol, most patients are seen:
- About 2–3 times pre-op
- About 7 times post-op over about six months
Patients complete the rest of their physical therapy at home. Pre-op rehab has been a key part of the protocol for optimizing surgical outcomes and helping patients return to the field and/or their lives since 1989.
More Patient Education
Complete and ongoing patient education is a key component of the Shelbourne Knee Center rehab protocol. “We educate patients on where they’re at, where they want to get to, and how they’re going to get there. That allows them to be accountable for their treatment,” says Bauman.
During visits, Bauman and other physical therapists teach patients how to do the exercises, then observe to ensure that they can do them correctly at home. Education and accountability result in high rates of compliance and rehab-goal achievement.
ACL Rehab
Pre-op rehab focuses on achieving full range of motion (ROM) and returning the knee to a normal state (except for the ACL tear) before surgery, which speed up recovery time and allows patients to more easily achieve their goals(1).
Shelbourne Knee Center’s accelerated post-op ACL rehab protocol includes:
- Eliminating swelling by lying down with the knee above the heart for the first five days
- Full extension exercises beginning the day of surgery
- Hospital stay for 23 hours
- Weight-bearing allowed as tolerated for bathroom privileges
- Emphasizing ROM exercises for flexion while maintaining full knee extension
- Strengthening exercises beginning when full extension and flexion is achieved
Knee Osteoarthritis Rehab
The Knee Rehabilitation Program for OA is based on the practice’s long-term data on ACL reconstruction patients(2). Like pre-op rehab for ACL injuries, it focuses on achieving full ROM.
Most patients with knee osteoarthritis (OA) find that rehab helps them enough that they no longer need total knee arthroplasty (TKA). Patients who improve their ROM through rehab but still have significant pain usually have TKA. The pre-op improvements made through rehab facilitate a better surgical outcome and a faster, easier recovery.
Post-op rehab after TKA focuses first on improving ROM and minimizing swelling, and then progresses to strengthening.
Long-Term Function
Education from Shelbourne Knee Center’s physical therapists enables patients to maintain their gains after they complete therapy. Patients learn about maintenance strategies, including how to identify and solve problems early.
ACL reconstruction patients, for example, learn to look for signs of asymmetry between the knees, swelling or stiffness in the reconstructed knee, or soreness in the graft knee. They learn how to tailor their activity level if any of these things occur.
Patients with knee OA learn that pain with activity usually means the knees are asymmetric. When this happens, they know they need to go back to doing their ROM exercises.
For more information about research-backed rehab for knee injuries and problems, call 888-FIX-KNEE.
References
1. Biggs A, et al. Rehabilitation for patients following ACL reconstruction: A knee symmetry model. North Am J Sports Phys Ther. 2009;4:2-12.
2. Shelbourne DK. Thirty-five Years of ACL Reconstruction, presentation at Andrews University, February 2018.